The main goal of the project is to reduce the experience of procedural pain (when changing bandages) in patients with burn trauma through a developed and pilot-tested application for virtual reality (VR).
The first study on this topic was performed in the USA on two pediatric patients (Hoffmann et al. 2000). In addition to pharmacological pain therapy, there are a number of non-pharmacological options (eg listening to music, relaxation techniques), which are based on distraction from the feeling of pain. VR appears to be the most promising of these options and, in addition to distraction, also reduces anxiety and depressive symptoms and increases patient compliance (Scapin et al. 2018), with studies also agreeing on a favorable role for immersiveness, i. feeling immersed in VR (eg Tribert et al. 2014).
The whole project will be preceded by a pilot verification in order to choose an adequate approach for the implementation of research design, including the creation of a new application for the CoR respecting current technological developments in this area. Part of the pilot verification will be the creation of its own application based on experience from already created applications for medical purposes in VR for patients with burn trauma in cooperation with Space s.r.o. (cf. Chan et al. 2018). A patient meeting the selection criteria (eg extent of burns, consent to be included in the study, etc.) will be enrolled in the study after the second dressing in the dressing room.
It is with dressings that procedural pain occurs first when removing old bandages and then removing necrotic tissue and applying new bandages. Each of these painful procedures can thus be divided into two parts, ie 1) removing old bandages; 2) removal of necrotic tissue and application of new dressings. In the study, we will repeatedly measure pain sensation using VAS (Visual Analog Scale) and BSPAS (Burns Specific Pain Anxiety Scale) in both parts of at least 30 patients. Before each dressing, it will be randomly chosen whether the VR will be used on the first part (scanning of old dressings) or only on the second part (removal of necrotic tissue and application of new dressings). In addition, we will evaluate the part with VR using a short inventory of immersiveness. Finally, it will be possible to assess the effect of VR on pain management during dressings in patients with burn trauma.
The first study on this topic was performed in the USA on two pediatric patients (Hoffmann et al. 2000). Since then, many other studies have been conducted on the use of VR in reducing pain in burn trauma worldwide, for example, a review study on the use of VR in the treatment of burn patients (Scapin et al. 2018) lists 799 studies. In addition to pharmacological pain therapy, there are a number of non-pharmacological options (eg hypnosis, listening to music, relaxation techniques, watching TV, etc.), which are based on distraction from the feeling of pain. VR appears to be the most promising of these options and, in addition to distraction, reduces anxiety and depressive symptoms and increases patient compliance (Scapin et al. 2018). Studies on the use of VR in the treatment of burns also agree that the greatest effect occurs especially in people who are most able to immerse themselves in VR and have so-called immersiveness (eg Tribert et al. 2014). Although pain is a spontaneous response to a painful stimulus, this process is still controlled. It can thus be partially controlled via VR applications. The most commonly used application for this purpose is the SnowWorld application from 1996, which, however, is obsolete from today’s point of view, and therefore does not create the desired immersiveness that can be expected for software respecting current technological developments in this area.
In Europe, with a few exceptions (eg Germany, the Netherlands), the effect of VR in the treatment of burns has not yet been studied (Morris et al. 2009; Triberti et al. 2014; Chan et al. 2018 and Scapin et al. 2018). None of the relevant studies include a control group, nor is information published on the pilot validation of published designs. Although the relevant studies have repeatedly hypothesized that the degree of immersion has an effect on the experience of pain as it is reduced through VR application, this hypothesis has not yet been experimentally tested. And that is exactly what we want to deal with in the submitted project.
The use of VR in reducing pain has been consistently confirmed since 2000. Although it is often hypothesized in the thematic literature that the greatest effect occurs in those patients with burn trauma who are most able to immerse themselves in VR (ie they have a higher degree of immersion), so this hypothesis has never been satisfactorily experimentally verified. The novelty of the proposed research solution lies in the experimental verification of the relationship between increasing immersion rate (measured by IPQ = Igroup Presence Questionnaire) and decreasing pain (measured VAS = Visual Analog Scale for Pain; BSPAS = Burns Specific Pain Anxiety Scale) in patients with burns trauma.